Role of Shame in Recovery from Substance Use Disorder

In a recent New York Times article, psychiatrist Sally Satel and psychologist Scott Lilienfeld discuss how shame can be useful in recovery from addiction. I find their position to be provocative, perhaps controversial to some.

Recalling Erickson’s psychosocial stages of development, one of the early stages during childhood involves the mastery of enhanced autonomy or shame and doubt.

We think of shame as a paralyzing emotion with destructive implications. We know that in Asian cultures, humility and shame play a prominent role in personal development by reminding us that we do have obligations and responsibilities to others. As one of many emotions, it is universally experienced, but not considered one of the universally expressed emotions like sadness or happiness or anger.

Satel and Lilienfeld acknowledge the potentially destructive impact of shame, as it can be associated with serious trauma which needs to be addressed and resolved in psychotherapy. They indicate that disorders such schizophrenia or bipolar disorder are beyond the person’s scope to control. However, they indicate the opposite is true about substance abuse. They emphasize, and so do I, that we all need to take a degree of responsibility to correct our destructive patterns.

They cite research presented in the Journal of Personality and Social Psychology conducted at the University of Connecticut by Colin Leach and Attila Cidom as a confirmation of the importance of focusing on shame during professional care.

Psychology recognizes the important functions of human emotions as crucial to our survival. They also energize us and function as potent social signals. Psychology also references the concept of locus of control, whether or not it is internal or external. Those with an internal locus will assume more responsibility for self; whereas the external locus indicates little responsibility for self. And when working with substance-abusing clients, clinicians will confront their defensive triad: denial, minimization, and projection of responsibility onto others.

As we examine the 12 steps of recovery, at least initially, the client must accept her powerlessness over her drug abuse; however, in later steps, taking a self-inventory becomes important. Then they make amends to those they’ve hurt. And in substance abuse work, I point out to my clients all those around them that they destroy. I refer to this consequence as the co-connected experience. The final step involves reaching out to others who are abusing substances. All this involves taking direct responsibility of our actions.

So, professionally, I agree with Satel and Lilienfeld about harnessing the power of shame in psychotherapy once the therapeutic alliance between client and clinician is established. Shame indicates to me that the client cares about their situation. Otherwise, our clients will continue down a destructive path towards premature death, and will take others down with them.


Carducci BJ. (2006). Psychology of Personality. Boston: Blackwell Publishing.

Erickson, EH. (1963). Childhood and Society. NY: Norton.

Erickson, EH. 1982). The Life Cycle Completed: Review. NY: Norton.

Satel, S. & Lilienfeld, S. (23 January 2016). Can Shame Be Useful? New York Times. Accessed online 31 January 2016.

Image via StockLite / Shutterstock.

Richard Kensinger, MSW

Richard Kensinger, MSW, has over forty years of clinical experience in behavioral healthcare as a psychotherapist, trainer, consultant, and faculty member in the Psychology Department, Mount Aloysius College. He has also taught at Penn State, University of Pittsburgh, and Temple University. He is also a lover of "football", known in the USA as soccer. He is currently associated for over 30 years with youth "football", 26 as a referee.
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